Durable Medical Equipment (DME), Prosthetics, Orthotics and Supplies (DMEPOS) as defined by the Department of Health and Human Services and its Center for Medicare Services (CMS) is a class of medical devices, products and supplies that are typically reimbursable under Part B of the U.S. Medicare health care program. In general, this category of products includes items provided to patients who receive outpatient treatment for certain health problems that do not require inpatient admission to a hospital or other healthcare institution. DMEPOS items are typically provided or prescribed to help alleviate, treat or assist in recovery from the condition that prompted the outpatient treatment of the patient. Such outpatient treatment can occur in any number of settings, such as a hospital emergency department, a clinic, or a physician's or therapist's office.
In general, the costs of DMEPOS items are reimbursable or payable separately from the healthcare professional's fee for treatment of the patient. DMEPOS items are typically reimbursable or payable in both Medicare and Medicaid programs and through private health insurers. Traditionally, most DMEPOS items were prescribed by the treating professional and those prescriptions could be filled by DME shops, Orthotics/Prosthetics shops, pharmacies with DME services, etc. However, as a convenience to patients many healthcare providers would like to dispense DMEPOS items at the time of treatment of the patient in order to facilitate patient convenience and continuity of care.
Since DMEPOS items are typically reimbursable or payable under a different billing and reimbursement system than professional healthcare services, it has been difficult for healthcare professionals to provide the dispensing of these items as an adjunct service to their patients. The specialty shops that have traditionally dispensed these items have developed the business processes necessary to properly stock the products, manage the inventory, properly associate prescriptions for DMEPOS items with appropriate coding under the CMS coding system, generate the regulatory paperwork for delivery of the item to the patient and generate the necessary forms for submission to the reimbursement agency such as Medicare, Medicaid, or private insurance.
Healthcare providers have a need to dispense DMEPOS items as an adjunct service to their medical practice, without having to individually develop all of the business processes which suppliers have developed previously and without the labor and overhead costs associated with those types of suppliers. Healthcare providers need to be able supply the patient with DMEPOS products that the healthcare provider has evaluated and knows to be appropriate for the patient's particular diagnosis and indications. It would be a significant advantage for the patient if the healthcare provider could provide the DMEPOS item at the time of initial diagnosis and treatment of the patient. This would allow the healthcare provider to properly fit the item to the patient and instruct the patient on the proper use of the item. For the patient, this would minimize the hassle of having to go to other locations to complete the diagnosis and treatment, and would generally result in better continuity of care.